To investigate the clinical characteristics and potential risk factors for concurrent ischemic stroke in patients with eosinophilic granulomatosis with polyangiitis (EGPA). Methods: A retrospective selection was conducted on 76 EGPA patients diagnosed at our hospital between January 2015 and December 2025, who were enrolled in the EGPA group. These patients were further divided into a stroke subgroup (8 cases) and a non-stroke subgroup (68 cases) based on the occurrence of concurrent ischemic stroke. Baseline clinical data, the Birmingham Vasculitis Activity Score (BVAS), and organ involvement were collected. Additionally, 220 healthy examinees from the same period served as controls (control group). Given the limited number of positive outcome events, univariate analysis, Spearman correlation analysis, and high-risk phenotype overlap analysis were employed to explore the risk factors for ischemic stroke in EGPA patients. Results: Among the 76 EGPA patients, the incidence of ischemic stroke was 10.52% . Compared with the non-stroke subgroup, the stroke subgroup exhibited significantly higher baseline disease activity (median BVAS: 45.00 v.s. 5.00, P=0.003), a significantly higher positive rate of Antineutrophil Cytoplasmic Antibodies (ANCA) (50.0% v.s. 8.8%, P=0.047), and elevated myeloperoxidase (MPO)-ANCA titers (P=0.010), alongside an extremely high proportion of cardiac involvement (50.0% v.s. 0, P=0.021). Correlation analysis demonstrated that the BVAS was the core factor linking the immunological phenotype (MPO titer) with target organ damage (cardiac involvement). High-risk phenotype overlap analysis indicated a high degree of heterogeneity in the occurrence of ischemic stroke, with 37.5% of patients presenting a "triple overlap" of high BVAS, ANCA positivity, and cardiac involvement. Conclusion: An extremely high systemic inflammatory burden (BVAS), ANCA-positive phenotype, and concurrent cardiac involvement constitute the core warning signals for EGPA complicated by ischemic stroke. Clinically, vigilance should be maintained for this high-risk subgroup, and targeted cardio-cerebrovascular screening should be conducted in a timely manner.